Open AccessShort‐ and long‐term perinatal outcome in twin pregnancies affected by weight discordance
Author(s) -
Vedel Cathrine,
Oldenburg Anna,
Worda Katharina,
Larsen Helle,
Holmskov Anni,
Andreasen Kirsten R.,
Uldbjerg Niels,
Ramb Jan,
Bødker Birgit,
Skibsted Lillian,
Sperling Lene,
Hinterberger Stefan,
Krebs Lone,
Zingenberg Helle,
Weiss EvaChristine,
Strobl Isolde,
Laursen Lone,
Christensen Jeanette T.,
Ersbak Vibeke,
Stornes Inger,
KramplBettelheim Elisabeth,
Tabor Ann,
Rode Line
Publication year - 2017
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13062
Subject(s) - medicine , percentile , confidence interval , odds ratio , gestational age , obstetrics , logistic regression , birth weight , small for gestational age , pregnancy , pediatrics , statistics , genetics , mathematics , biology
The objective was to investigate the association between chorionicity‐specific intertwin birthweight discordance and adverse outcomes including long‐term follow up at 6, 18, and 48–60 months after term via Ages and Stages Questionnaire. Material and methods In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity‐specific birthweight discordance: <75th percentile, 75th–90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow‐up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins. Results The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11–2.65) and odds ratio 2.83 (95% confidence interval 1.73–4.64), respectively]. Discordance >75th‐percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07–20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48–60 months after term. Conclusion Chorionicity‐specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48–60 months.